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Maine rates for HCPCS 15277

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,674.23 / $2,674.23 / $2,674.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.51 / $272.64 / $554.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.32 / $359.56 / $518.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$247.79 / $417.43 / $676.44
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.94 / $424.64 / $707.85
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,674.23 / $2,674.23 / $2,674.23
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.51 / $272.64 / $554.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$328.22 / $444.74 / $681.67